What is ovarian cancer?

Ovarian cancer is cancer of the ovaries and the fallopian tubes.

The fallopian tubes attach the womb to the ovaries. They collect the egg when it is released from the ovary and transport the egg to the womb.

Doctors now think that many ovarian cancers may start in the end of fallopian tubes where they attach to the ovary. Ovarian cancer happens when cells in the ovary or fallopian tube become abnormal. These cells can grow and divide uncontrollably.

These cells can fall off from the surface of the ovary or the lining of the fallopian tube and spread throughout the abdominal (tummy) cavity. The cells then attach to the lining of the abdominal cavity (called the peritoneum) or onto the outside of other organs, like the bowel. They can grow into further tumour deposits called metastases. In ovarian cancer, this spread can happen very early, even when there isn’t a visible mass on the ovary or tube. Eventually the abnormal cells can spread to other organs outside of the abdominal cavity.

How common is ovarian cancer?

Around 7,500 women get ovarian cancer in the UK each year. It is most common in women over 50, but younger women can still get it. Some rarer types of ovarian cancer are more common in younger women. Ovarian cancer can affect anyone who has fallopian tubes or ovaries, so some trans men and some non-binary people can also be affected.

What can increase the risk of ovarian cancer?

We don’t yet know the cause of ovarian cancer. The biggest risk factor for ovarian cancer is getting older and the risk rises steeply from the age of 45. It is most common in women and people who have been through the menopause.

You might also be more at risk of ovarian cancer if a close blood relative, like your mum or sister, has had ovarian cancer, or if you have a family history of breast cancer. This is because some ovarian cancers are caused by an inherited faulty gene – BRCA1 or BRCA2. If you are worried about this, speak to your GP as they can assess your risk and decide whether you would benefit from a referral to a specialist genetics testing service. Lynch Syndrome affects 1 in 278 people and causes some families to have high rates of some types of cancer, including bowel, womb, prostate, ovarian and stomach cancer.

Around 5-15% of ovarian cancers are caused by a genetic mutation. If you are found to have an inherited risk of ovarian cancer, you can be offered surgery to remove your tubes and ovaries to reduce your risk significantly. Surgery is offered if you do not hope to get pregnant in the future.

Other factors that can affect your risk of ovarian cancer include:

• being younger than average when you started to have periods
• being older than average when you stop having periods at the menopause
• prolonged use of HRT
• being overweight
• smoking

What can reduce the risk of ovarian cancer?

Some things can reduce your risk of ovarian cancer:

• taking the combined oral contraceptive pill for 5-10 years. This can halve your risk of developing ovarian cancer
• removing your fallopian tubes at the time of other abdominal surgery

It's estimated that 35% of cases of ovarian cancer are preventable.

What are the symptoms of ovarian cancer?

Symptoms of ovarian cancer are not always obvious, and some people may not notice them, or think they are symptoms of other conditions.

If you do notice symptoms of ovarian cancer, they’re most likely to include:

• persistent swelling of the tummy, often described as bloating. This is called ascites and is caused by extra fluid. More than one in three people with ovarian cancer will have this
• tummy or pelvis pain that keeps coming back
• reduced appetite and feeling full quickly when you eat
• needing to wee more often.

Other symptoms include:

• unexplained weight loss
• extreme tiredness
• changes to your bowel habit (constipation or diarrhoea)
• vaginal bleeding after you have been through the menopause.

If you have any of these symptoms, you should speak with your GP. These symptoms can be often caused by other benign conditions, such as irritable bowel syndrome (IBS), but it’s important to get checked out. This is especially important if you’re over the age of 45 or have been through the menopause.

It’s a good idea to keep a diary of your symptoms and take this when you visit your GP. Useful things to record include date and time of symptoms, if anything makes symptoms worse, when they started and how often they occur. You may want someone to go with you to your appointment for support.

How is ovarian cancer diagnosed?

The earlier ovarian cancer is diagnosed, the easier it is to treat. Unfortunately, we don’t yet have effective ways to screen for ovarian cancer.

A GP will first ask you questions about your symptoms. They may investigate further and:

• examine your tummy
• carry out an internal vaginal examination to feel for lumps or tenderness inside your pelvis.
• check your cervix (the neck of your womb). They will use a tool called a speculum to open your vagina so they can see your cervix better. If your cervical screening test is overdue, they may do this at the same time to keep a check on any signs of cervical cancer as well.
• arrange for a blood test, called CA125.

Depending on the outcomes of their investigations, doctors may arrange an ultrasound scan of your tummy and pelvis. This may lead to a referral to a gynaecology cancer specialist. Sometimes your doctor will refer you straight to the specialist before the test results are back. The specialists may arrange for further tests like blood tests, scans or biopsy before they see you.

The cancer may be staged and graded to help inform the treatment plan. This describes the size, whether it has spread and the changes in the cells. Find out more about staging ovarian cancer on the Macmillan website.

If they don’t refer you for investigation and you’re still concerned, it’s okay to ask them why and for more information.

If the tests are initially reassuring, but your symptoms persist or worsen over the next few weeks or months, go back to visit your GP again.

What are the treatments for ovarian cancer?

The treatments you receive will depend on the stage and type of ovarian cancer you have.

In some cases, when it is caught early, ovarian cancer can be completely treated. For others the treatment may help to control the disease for months or years before it comes back. All treatments are likely to trigger menopause however, if you have not yet been through the menopause.

Treatments is often a combination of:

• surgery
• chemotherapy
• radiotherapy
• hormone treatments
• targeted drug treatments

If you are diagnosed with ovarian cancer, your doctor will discuss treatment options with you. You will also be able to ask them any questions that you might have. You will also be assigned a cancer nurse specialist who will be your contact person and is there to support you through your treatment.

It is a good idea to discuss what your options are, and the benefits and risks of each, so that you can reach a decision that is best for you.

Can I still get pregnant?

Many people with ovarian cancer will need to have their ovaries, fallopian tubes and the uterus (womb) removed during surgery. This means you won't be able to become pregnant naturally. There may be other ways to have children such as IVF, surrogacy or adoption.

Sometimes it’s possible to have treatment to remove just one ovary, which means you may still be able to get pregnant in the future.

Ask your doctors and nurses for information about your fertility options.

Getting support

Worries about a possible diagnosis or living with cancer can be very challenging. Sometimes it can help to speak to people who understand and have experience of an ovarian cancer diagnosis.

You can read Sbba’s story and Amy’s story of ovarian cancer.

You can read more about ovarian cancer and the treatments available on the NHS website.

If you are worried about ovarian cancer or have been recently diagnosed, you can get support. These organisations offer information, help and advice:

• Ovarian Cancer Action
• Target Ovarian Cancer
• Ovacome
• Cancer Research UK
• Macmillan

You can also watch our webinars on gynaecological cancers, which feature experts and people with lived experience:

Let’s talk gynaecological (gynae) cancers – with Dr Neil Ryan and Sbba Siddique

Let's talk gynaecological cancers webinar – with Dr Sarah Kitson

Read about our ovarian cancer research

As a women’s health charity, we fund research to save and change the lives of women, girls and babies.

Our research has identified that a simple blood test, which can be given by GPs, could help diagnose ovarian cancer faster and more accurately.

We are currently funding research to understand:

• If we can prevent some advanced ovarian cancers from becoming resistant to chemotherapy
• If our cells can be ‘re-educated’ to fight ovarian cancer
• What causes a rare and serious type of ovarian cancer, which is more common in younger women
• How healthcare professionals can deliver better ovarian cancer care for older women
• Why ovarian cancer becomes resistant to chemotherapy, this is when the treatment is no longer effective against the cancer
• Understand how, why and when some advanced ovarian cancers become resistant to a type of treatment called PARP inhibitors